So far, 2025 has been a terrible year for global health. The Trump Administration is slashing funding to a number of international programs; closing down USAID, the government’s major aid development arm; and withdrawing U.S. membership from the World Health Organization.
But a glimmer of hope arrived on May 8, when Bill Gates, chair of the Gates Foundation, announced that he will be infusing the struggling field with most of his fortune—$200 billion, which he built after creating Microsoft—to be spent by 2045. He also plans to close down the foundation at that time.
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Since Gates and his former wife, Melinda French Gates, created the foundation 25 years ago, the organization has contributed more than $100 billion to global causes, primarily in health. The Gates Foundation helped to create two important international health organizations: GAVI, which provides the world’s children with lifesaving vaccines, and the Global Fund, which focuses on distributing treatments for HIV, TB, and malaria.
Gates’ just-announced timeline represents an acceleration of foundation’s timetable. When it was created, the board agreed to sunset the organization about 20 years after the Gates’ deaths.
Gates, who turns 70 this year, spoke with TIME about why he decided to speed up his plans.
When did you start thinking about closing the foundation earlier than you previously planned?
Over the last two years, I’ve been talking with [Gates Foundation CEO] Mark Suzman and the foundation board about this. And we decided to double down to get some infectious diseases either dramatically reduced or eradicated, which is exciting.
It is ironic that the announcement ended up being at a time where the funding for global health is in incredible crisis because of a lot of cuts being made and some that are being discussed. This was not a response to that. But perhaps my commitment to give all of it away will remind people how important and how effective these dollars are, and the basic value of reducing childhood deaths. So it was late last year that I really put it to the board and talked about doubling down.
It was also late last year, in December, that you had a three-hour dinner with now-President Trump, and you’ve said you were “impressed” with his questions about polio and HIV. That discussion wasn’t part of your consideration to accelerate your timeline?
In the two discussions I had with President Trump since he was elected—on Dec 27. and Feb. 5—he was quite supportive of our work in HIV and polio. It’s Congress who will set the budget going forward, and historically, PEPFAR, which was created by President Bush [to provide HIV treatments] and GAVI had bipartisan support, and less than 1% of the U.S. budget goes to these things. Some of that funding has been cut off right now, in fact in a pretty abrupt way. We need to get Congress to weigh in.
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I am hopeful that we can get a lot of that funding restored, but we do have challenges in a lot of rich countries where budgets are very tight, and they are under pressure to increase defense budgets. Over the next four years, we are likely to see an increase in childhood deaths for the first time since the turn of the century, and I am very dedicated to changing things to help us get back to making progress. We need rich world governments to restore some of this funding; we need more engagement by philanthropies to help out. And incredible innovations mean whatever money we have can be used even more effectively. Over [the next] 20-year period, I am actually quite optimistic, although we are in an awful emergency right now.
Given the U.S. withdrawal from the WHO, could the Gates Foundation play a bigger role in working with the WHO to fill in some of the funding gap?
The WHO is a key partner for us. In fact [WHO director general] Tedros [Ghebreyesus] was in Singapore with me on Tuesday, and we were talking about the reorganization he is going through and decisions he has made. WHO plays a big role in polio and most of the things we do in global health. Strangely, now that U.S. cut so much, the Gates Foundation is now the largest single donor to WHO. I don’t think in the long run that’s the way it should be. A big part of that is the work we do in polio, but we fund a dozen things at WHO.
But I think eventually the U.S. will state whatever it wants to see changed and resume as a member, because in so many areas, WHO is critical, including whenever we have a potential pandemic. You know, we funded a lot of the improvement pandemic preparedness of the WHO based on lessons that came out of the COVID vaccine effort. I don’t think the U.S. will go back in right away, but we’ll be somebody to help broker a dialogue that eventually gets the U.S. back there, which think is valuable to the world and U.S.
How concerned are you by the current situation in global health, with the U.S. making such big cuts in its contributions?
I would have guessed because the U.S. does have problems with the deficit, we might see a 15%-20% cut. I would have said, okay, we need to make sure we minimize the impact that has. I think it’s ideal at this point that we get back to that.
There are some proposals to Congress from the executive branch which would represent an almost 80% cut. That would be tragic. We are going to see deaths from children go up, and they have been going down at a record rate since 2000, from 10 million to under 5 million. We are going to see it go the wrong way, and that means millions of extra deaths. Some of the cut-offs have been quite abrupt.
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We will get a real gauge of this global health emergency in June in Brussels, for the five-year replenishment of GAVI: that entity we started in 2000 together with rich world governments to buy vaccines for the world’s poorest children. The metric will be—can we raise as much as we raised five years ago, or will we be substantially below that? I have to tell you, right now, it looks pretty grim. Including getting the U.S. to buy these very inexpensive vaccines. These are $1 vaccines, and the majority of the reason we had reductions in deaths from around 10 million to five million is because of vaccines. To not be able to buy $1 vaccines when we are talking [about something] that is well under 1% of the U.S. budget, I think that’s tragic. We will try to make the case, try keep the U.S. in HIV medicines, where they have been very generous, starting with President Bush. The Global Fund replenishment will come in the fall, and right now, it all looks like it could be a disaster.
More studies are showing that making an impact on health requires addressing non-medical factors as well, and the Gates Foundation has supported programs in education and nutrition. How important will these be over the next 20 years?
If you look at the breakdown of the foundation spending, which is just over $100 billion over the last 25 years, by far the biggest is in global health, with 35% creating new, low-cost tools and 35% helping to get those tools delivered.
Next up is education, which is about 15%. That’s always been something where because I got such a great education here in the U.S., I felt like we should try to make that available to every student. We have done a lot with charter schools, curriculums, and scholarships. Now, we are using AI to improve curricula. We are able to get graduation levels up.
Agriculture is 8% of what we have done. The opportunity to make seeds more productive, and crops more nutritious either by improving seeds or doing food fortification by adding some micronutrients in later—that’s super important work. Particularly in Africa where with population growth and climate change, the only way to help the poorest there—the majority of whom are farmers—is by improving their seeds and access to fertilizer.
One of the most amazing programs we’ve done is taking chickens in Africa and used cross-breeding with highly productive chickens from Europe and the U.S. to get a lot more eggs. Now we have over 200 million chickens that have been delivered to women in Africa that both help nutritionally, and help them economically. It’s a very exciting area. The agriculture work has as high impact as our health work.
How well has the foundation addressed the goals and vision you set out when you created it 25 years ago?
The progress in health is way beyond what I would have expected. Tens of millions of lives have been saved because of our work and through our partnerships—over 100 million lives. It’s not just us. There has been a movement, and we have been a central part of that.
In areas like education, we have done great things—graduation rates have gone up but not nearly as miraculous. I slightly expected us have more impact in education and I had no idea we we’d be able to have such incredible results in our health work. So we’re learning all the time. We’ve got a pipeline of innovation that is far, far stronger than ever before. And we have AI that’s going to supercharge that—both the discovery piece and the delivery piece. So I have pretty high expectations for the next 20 years, despite the funding emergency that we’re in .